Basic Information
| Provider Information | |||||||||
| NPI: | 1790968667 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELENA NEVEUX OD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 487 BAYOU VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | TARPON SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346893607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723498877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9797 BAY PINES BLVD | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337083775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273985090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2007 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | NEVEUX | ||||||||
| AuthorizedOfficialFirstName: | ELENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7723498877 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC 3930 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 621231000 | 05 | FL | MEDICAID |